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Kinetics of procalcitonin, interleukin 6 and C-reactive protein after cardiopulmonary-bypass in children

Published online by Cambridge University Press:  18 April 2005

Maurice Beghetti ,
Peter C. Rimensberger ,
Afksendiyos Kalangos ,
Walid Habre  and
Alain Gervaix
Maurice Beghetti
Affiliation:
Cardiology Unit, University Hospital Geneva, Switzerland
Peter C. Rimensberger
Affiliation:
Intensive Care Division, University Hospital Geneva, Switzerland
Afksendiyos Kalangos
Affiliation:
Cardiovascular Clinic, Department of Surgery, University Hospital Geneva, Switzerland
Walid Habre
Affiliation:
Anesthesiology Unit, Department of Anesthesia, University Hospital Geneva, Switzerland
Alain Gervaix
Affiliation:
Infectious Disease, Department of Pediatrics, University Hospital Geneva, Switzerland
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Abstract

Cardiopulmonary bypass induces a generalized inflammatory response, with fever and leukocytes, which is difficult to differentiate from an infection. Recently, procalcitonin has been proposed as an early and specific marker of bacterial infection. The influence of cardiopulmonary bypass on production of procalcitonin, therefore, must be assessed before considering this molecule as a valuable marker of infection after cardiac surgery in children. With this in mind, we measured levels of procalcitonin, interleukin 6, and C-reactive protein before and 6 h, 1, 3 and 5 days after cardiopulmonary bypass, in 25 children undergoing cardiac surgery. Cardiopulmonary-bypass induced a transient increase in procalcitonin, with a peak at 24 h, with a median of 1.13 μg/l, a 25th and 75th interquartile of 0.68–2.25, and a p value of less than 0.001. The value had returned to normal in the majority of the children by the third day after surgery. Peak values correlated with the duration of cardiopulmonary-bypass, with a r-value of 0.58 and a p value of 0.003; cross-clamp time, with a r-value of 0.62 and a p value of 0.001; days of mechanical ventilation, with a r-value of 0.62 and a p value of 0.001; and days of stay in intensive care, with a r-value of 0.68, and a p value of 0.0003. The value returned to normal after 3 days in 83% of the patients. Levels of interleukin 6 and C-reactive protein also increased significantly after surgery, and remained elevated for up to 5 days.

Thus, in contrast to other markers, levels of procalcitonin in the serum are only slightly and transiently influenced by cardiopulmonary bypass, and may prove to be useful in the early recognition of an infection subsequent to cardiopulmonary bypass.

Keywords

Complementheart surgerypediatricsintensive care
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 2 , April 2003 , pp. 161 - 167
Copyright
© 2003 Cambridge University Press

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Footnotes

Source of support: Immunoluminometric assays for procalcitonin (LUMItest PCT, Brahms Diagnostica, Berlin, Germany) were provided by Brahms Diagnostica.

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